Associazione Nazionale Medici Cardiologi Ospedalieri



Role of right ventricular myocardial work in the stratification of patients affected by Advanced Heart Failure

Manca Paolo Palermo(PA) – ISMETT | Rugiano Gerardo Caltanisetta(Caltanisetta) – Azienda Sanitaria Provinciale di Caltanisetta | Nuzzi Vincenzo Palermo(PA) – ISMETT

Background: Currently adopted echocardiographic parameters for the evaluation of right ventricle (RV) are all loading sensitive and their reliability remains poor. RV myocardial work (RVMW) emerged as an innovative non-invasive diagnostic tool that incorporates strain pressure loops and potentially overcomes the aforementioned limitation. No previous studies assessed the variations of RVMW depending on the hemodynamic setting.

Aim of the study: To evaluate the different values of RVMW in patients affected by advanced heart failure (AHF) with and without pulmonary hypertension (PH) at right heart catheterization (RHC) and their variations in patients with baseline PH who subsequently achieved PH reversibility.

Methods and results: All patients with AHF who underwent RHC and echocardiography within 24h at Istituto Mediterraneo per I Trapianti e Terapie ad Alta Specializzazione (ISMETT) since 01/05/2023 were prospectively enrolled. Patients with baseline documented PH who achieved PH reversibility at RHC underwent a second echcocardiographic assessment under the same hemodynamic conditions. The following components of RVMW were analysed: 1) RV global work index (RVGWI); 2) RV global constructive work (RVGCW); 3) RV global wasted work (RVGWW); 4) RV global work efficiency (RVGWE).

Overall, 41 patients were enrolled (16 without PH and 25 with PH). Patients with PH had a higher RVGWI (341±133mmHg% vs 207±104mHg%; p=0.002) and RVGCW (450±153mmHg% vs 294±114mmHg%; p=0.001) compared to those without, while RVGWE did not differ in the two groups (80 ±10mmHg% vs 80 ±15mmHg%; p=0.92). A trend toward a higher RVGWW in patients with PH was observed (89±54mmHg% vs 59 ±66mmHg%; p=0.12). Among the 25 patients with PH, 10 were tested for PH reversibility and this was achieved in 9/10 (90%). RVGWI and RVGCW significantly dropped once PH reversibility was achieved (respectively from 393 ±185mmHg% to 241±67mmHg; p=0.008 and from 435±127mmHg% to 268±67mmHg%; p=0.048). Interestingly, RVGWE remained almost unchanged (from 81±11mmHg% to 79±9mmHg%; p=0.661) while there was a nearly significant trend in RWGWW decrease (from 65±20mmHg% to 41 ±22mmg%; p=0.076).

Conclusions: Patients affected by AHF and PH have significantly higher RVGWI and RWGCW compared to those without. However, RVGWE is similar between the groups and does not vary depending the hemodynamic setting, potentially identifying this parameter as the most reliable one in patients with AHF.